Would you like to tell us something about your situation? If so, please fill in the
following boxes. (This following information is NOT required.)

Please tell us a little about your situation. :

What are your biggest problems?

What would you like to see happen?

Total Unsecured Debt You Have?

$A rough estimate of the total is O.K. Unsecured debts
are debts like credit cards, medical bills, finance companies, and personal loans,
where none of your property listed as "collateral".

Total Monthly Minimum Payments?

$If you had the money to pay on all your unsecured
debts on time each month, how much would the minimum payments add up to. Just give
us an approximate amount. Is it $300 per month? $500 per month? $1,000 per month?
More?